失血性休克并发急性肺损伤大鼠蛋白激酶C的表达

目的 探讨蛋白激酶C（PKC）在失血性休克并发急性肺损伤动物体内的变化与意义.方法 健康成年雄性SD大鼠40只,随机分为对照组,失血性休克组和失血性休克＋内毒素组,以大鼠失血性休克时LPS所致ALI为模型,采用酶联免疫吸附（ELISA）法检测血清TNF-α、IL-1β及IL-6,Westernblot检测肺组织TLR4与PKC的蛋白表达,EMSA检测NF-κB活性变化,观察肺脏含水量、肺脏病理变化.结果 失血性休克早期即可发生肺血管通透性增高,肺脏含水量上升,组织学检查显示肺脏出现明显的病理损害,肺组织PKC与NF-κB DNA活性、TLR4同步增强,尤以内毒素作用后为著.结论 PKC的活化参与了失血性休克时ALI的发病,即TLRs/NF-κB信号通路的活化.     

大黄附子汤对重症急性胰腺炎肺损伤大鼠肺泡上皮屏障功能的影响

目的 探讨大黄附子汤对重症急性胰腺炎肺损伤大鼠肺上皮屏障功能的影响及意义.方法 96只SD大鼠随机分为假手术组、重症急性胰腺炎肺损伤组(SAP-ALI组)及大黄附子汤组三组,每组32只.各组再按3,6,12,24 h时间点分为四个亚组,每个亚组各8只.假手术组开腹后行空肠造瘘,翻动胰腺数次后关腹;SAP-ALI组在假手术组基础上经胰胆管逆行注入4%牛磺胆酸钠(1mL/kg),建立重症急性胰腺炎急性肺损伤模型;大黄附子汤组在SAP-ALI组基础上经空肠造瘘管注入大黄附子汤10 mL.各组按时间点分别于伤后3,6,12,24 h测定肺泡上皮通透性(AEP)、肺泡内液体清除率(ALCR)、总肺水量(TLW)和肺血管外肺水量(EVLW),同时测定血浆内毒素(ET)、血清淀粉酶含量,光镜下观察肺脏病理组织学变化.结果 与假手术组比较,SAP-ALI组大鼠术后3,6,12,24 h ALCR显著降低,TLW,EVLW及AEP呈明显升高趋势(P＜0.05或P＜0.01).与SAP-ALI组比较,大黄附子汤组对大鼠术后3,6,12,24 h ALCR均显著升高,TLW,EVLW及AEP呈明显降低趋势(P＜0.05或P＜0.01),且肺组织的水肿、出血、炎症程度及肺损伤学评分和肺湿/干重比均明显好转.结论 重症急性胰腺炎并急性肺损伤大鼠存在严重的肺泡上皮屏障功能障碍;大黄附子汤通过抑制内毒素过度释放,可降低炎症反应,改善肺泡上皮功能障碍,减轻肺损伤程度.

Abstract：

Objective To investigate effect of Dahuang Fuzi decoction on alveolaur epithelial barrier in rats with lung injury with severe acute pancreatitis. Method Ninty-six health SD rats were randomly divided into three groups: sham operation group, SAP-ALI group, Dahuang Fuzi decoction group, and then according to the time point of sacrifice after operation, each group was subdivided into 3,6,12,24 hour subsets ( each, n = 8). After the belly of a rat in the sham operation group was cut open, the pancreas was flipped several times,and then a stoma was made in the jejunum to form its fistula. In the SAP-ALl group,1 mL/kg sodium taurocholate was reversely injected into the pancreatobile duct to establish the model of SAP, and then the jejimum fistula was performed. The SAP-ALI model in Dahuang Fuzi decoction group was treated by injection of 10ml of Dahuang Fuzi decoctionon into the fistula respectively. Blood was collected from heart to detect serum amvlase and endotoxin (ET) levels before the rat being executed. The lung histopathologic changes, pulmonary injury scores and wet/dry weight(W/D) ratios were observed after the rats were executed. The alveolar liquid clearance rate(ALCR), total lung water content (TLW), extravascular lung water content(EVLW) and alveolar epithelial permeability (AEP) were examined in 3,6, 12,24 h after injury.Results There was continuous increase of AEP,TLW and EVLW,as well as progressive reduction of ALCR compared with sham operation group at 3,6,12,24 h after operation. Compared with SAP-ALI group, there was continuous decrease of AEP,TLW and EVLW, and elevated of ALCR at 3,6,12,24 h after operation.Conclusions Dahuang Fuzi decoction can significantly reduce alveolaur epithelial barrier and degree of lung tissue of SAP-ALI rats by inhibiting the elevation of LPS and inflammation reaction.     

左房黏液瘤脱落致腹主动脉栓塞并发急性肾功能不全一例

患者,男,29岁,以"突发下肢无力伴尿少11 h"入院.患者11 h前劳动后突发下肢无力,左下肢疼痛,伴胸闷、尿少,就诊于当地医院行腹部血管彩超示腹主动脉栓塞,后来院行CTA检查可见腹主动脉血栓形成,双侧肾动脉平面以上堵塞(图1).患者既往近3年偶有阵发性心悸,未在意.入院体格检查T 36.8℃,P 86次/min,R 26次/min,BP 130/75 mmHg,神志清楚,心肺未见明显异常,腹软,腹部压痛明显,无反跳痛及肌紧张,左下肢皮肤暗紫,右下肢皮肤苍白,皮温凉,双下肢动脉均未触及搏动.     

大黄附子汤对急性坏死性胰腺炎大鼠小肠黏膜屏障功能的保护作用

目的 探讨大黄附子汤对急性坏死性胰腺炎(ANP)大鼠小肠黏膜屏障功能的影响及意义.方法 将60只SD大鼠按数字表法随机分为假手术组(19只)、ANP组(21只)和大黄附子汤治疗组(20只).经胰胆管逆行注入4%牛磺且酸钠1 ml/kg体重建立ANP模型,同时行空肠造瘘.治疗组于制模后0.5 h经空肠造瘘管注入大黄附子汤2 ml,隔4、8 h再注入2 ml;其他两组注入等容积生理盐水.术后24 h经腹主动脉取血,测定血淀粉酶、内毒素、D-乳酸含量及二胺氧化酶(DAO)活性.取胰腺、小肠组织行病理学检查,测定肠上皮损伤指数,观察小肠黏膜超微结构改变.结果 假手术组大鼠血淀粉酶、内毒素、D-乳酸含量及DAO活性分别为(152±32)U/L、(6.95±2.10)pg/L、(3.96±1.08)μg/ml和(14.26±2.67)μg/ml,ANP组分别为(1549±93)U/L、(40.48±3.41)pg/L、(12.34±1.23)μg/ml和(80.28±3.54)μg/ml,治疗组分别为(655±49)U/L、(19.55±2.50)pg/L、(6.75±1.36)μg/ml和(20.69±7.53)μg/ml,ANP组较假手术组明显升高,而治疗组较ANP组显著降低,但仍高于假手术组(P＜0.05或＜0.01).ANP组小肠黏膜厚度、绒毛高度分别为(389.44±29.87)μm、(16.52±3.73)μm,显著低于治疗组的(501.95±45.38)μm、(27.82±5.17)μm,更显著低于假手术组的(658.72±57.49)μm和(35.49±6.43)μm;而肠上皮损伤指数为3.72±0.65,显著高于治疗组的2.12±0.37和假手术组的0.85±0.24.同时,大黄附子汤治疗后小肠黏膜组织学和超微结构改变亦均较ANP组明显减轻.结论 大黄附子汤可明显减轻ANP大鼠小肠黏膜屏障功能损害的程度.     

急诊医学教学中两种教学方法实施效果的比较研究

目的 比较以问题为基础学习(problem-based learning,PBL)结合智能化计算机模拟教学与传统的以授课为基础学习(lecture-based learning,LBL)两种教学方法在急诊医学教学中的应用效果.方法 以大连大学医学院2006级五年制临床医学专业1班和2班49名学生为研究对象,1班25名学生为对照组,2班24名学生为实验组.两组学生在年龄、性别、基础文化程度、专业知识掌握等方面差异无统计学意义.针对心肺脑复苏章节的急诊教学,对照组采用LBL教学方法;实验组采用PBL结合智能化计算机模拟教学方法.教学结束后,采用问卷调查、理论及操作技能考核等主客观评价方法共同评价教学效果.结果 与对照组学生比较,实验组学生在教学中能够主动提出问题,积极参与讨论,发言踊跃,课堂气氛活跃.调查结果显示,学生对PBL结合智能化计算机模拟教学方法满意度高于LBL教学方法.比较两组学生的考试成绩,无论是理论测试还是操作技能考核,实验组学生的成绩均明显优于对照组学生(P<0.05).结论 PBL结合智能化计算机模拟教学比LBL教学更能够增加学生学习的兴趣,加深学生对知识的理解和记忆,增进团体协作精神,并且能够更好地培养学生急诊医学思维和解决临床问题的能力,显著提高了急诊医学的教学效果.

Abstract：

Objective To evaluate the application effects of problem-based leaning (PBL) combined with intelligent simulation teaching and lecture-based learning (LBL) in course of cardio-pulmonary-cerebral resuscitation of emergency medicine. Methods Using 49 undergraduate students of grade 2006, five-year clinical medicine in Medical School of Dalian University as the object of research, and class 1 (n=25) for control group, class 2(n=24) for experimental group. The students of control group were taught by traditional LBL teaching method, and experimental group were taught by PBL combined with intelligent computer simulations teaching method. The teaching effect was evaluated by using the results of questionnaire survey and theory examination skills and operating skills together. Results Compared with controls group, the students of experimental group were able to question actively and participate in discussions, spoken enthusiastically, and active atmosphere. The results of students' questionnaires showed that satisfaction of students for PBL combined with intelligent simulation teaching method were better than LBL teaching method. Test scores, either in theory or skills assessment test experimental results are better than control group (P<0.05). Conclusions Compared with traditional LBL teaching method, PBL combined with intelligent simulation teaching method can increase students' interest in learning, deepen understanding and memory of the knowledge, enhance team spirit and bring up ability to emergency medicine clinical thinking and solving practical problems, and improve the teaching effect of emergency medicine greatly.     

重症急性胰腺炎并发肺损伤促/抗炎症因子的变化及大黄附子汤的干预研究

目的观察大黄附子汤对重症急性胰腺炎并肺损伤（SAP-ALI）时血清促/抗炎症因子的影响。方法健康长白猪,体重25～30kg,13头,随机分成三组：对照组（n=4）、重症急性胰腺炎肺损伤组（模型组,n=4）、大黄附子汤治疗组（治疗组,n=5）。其中模型组采用主胰管内逆行注入4%牛磺胆酸钠（1ml/kg）诱导SAP-ALI模型。三组均于术后即刻、术后6h、12h、24h、48h、72h取血,ELISA法动态检测血清中促炎因子（TNF-α和IL-1β）、抗炎因子（IL-4）浓度变化,同时动态比浊法测定血清内毒素（LPS）含量。术后72h处死动物,计算肺组织湿/干重比,观察胰腺与肺病理形态学变化。结果模型组6～72h血清淀粉酶、内毒素、TNF-α、IL-1β浓度及肺病理组织学评分均较对照组明显升高（P〈0.05）,IL-4浓度在术后24h开始较对照组逐渐升高（P〈0.05）。治疗组各时间点血清淀粉酶、内毒素、TNF-α、IL-1β浓度均较模型组明显下降（P〈0.05）,但血清IL-4浓度于术后12h出现明显升高,48h达到峰值。结论促炎因子（TNF-α、IL-1β）、抗炎因子（IL-4）及内毒素等共同参与了SAP-ALI的发病过程。大黄附子汤通过降低血清LPS水平,进而下调血清TNF-α及IL-1β表达,上调IL-4表达,减轻SAP-ALI的程度。     

大黄附子汤对重症急性胰腺炎肺损伤大鼠肺组织Toll样受体4／核转录因子-κB的影响

目的 探讨大黄附子汤治疗重症急性胰腺炎-急性肺损伤(SAP-ALI)的作用机制.方法 将128只SD大鼠随机分为假手术组、SAP-ALI组、大黄附子汤组和血必净组,每组再按处死时间点分为术后3、6、12、24 h 4个亚组,每个亚组8只.假手术组开腹后翻动胰腺数次,行空肠造瘘;SAP-ALI组采用胰胆管逆行注入牛磺胆酸钠1 ml/kg制模,行空肠造瘘;大黄附子汤组和血必净组于制模后0.5 h经空肠造瘘管分别注入大黄附子汤或血必净注射液2 ml,其他两组注入等量生理盐水.各组在处死大鼠前从心脏取血,用全自动生化仪检测血清淀粉酶水平,动态比浊法测定血清内毒素含量.处死大鼠后取肺脏,观察肺组织病理学变化、计算肺损伤评分和湿/干重(W/D)比值;用蛋白质免疫印迹法(Western blotting)检测肺Toll样受体4(TLR4)/核转录因子-KB p65(NF-KB p65)的表达.结果 SAP-ALI组各时间点血清淀粉酶、内毒素,肺损伤评分及W/D比值较假手术组均明显升高(P均<0.05);大黄附子汤组各指标均显著下降(P均<0.05).Western blotting结果显示,SAP-ALI组TLR4、NF-KB p65表达于术后3 h开始较假手术组升高,12 h达高峰(P均<0.05);大黄附子汤组TLR4于术后3 h、NF-κB p65于术后6 h表达较SAP-ALI组显著降低,12 h达峰值(P均<0.05).结论 TLR4/NF-κB信号转导通路在SAP-ALI早期炎症级联反应中发挥了重要作用;大黄附子汤通过降低血清内毒素水平、降低肺组织TLR4的活化、抑制下游NF-κB p65转导路径,从而减轻SAP-ALI的进程.     

肠内免疫微生态营养对重症急性胰腺炎全身炎性反应及预后的影响

目的 探讨肠内免疫微生态营养对重症急性胰腺炎(SAP)全身炎性反应及预后的影响.方法 57例SAP患者在人院48 h内采用随机数字表法被随机分为肠外营养组(PN组)28例和肠内免疫微生态营养组(EIN组)29例,分别进行相应的营养支持7d.入院时及营养后1、3、5、7 d分别检测外周血内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性,并统计两组治疗结果.结果 入院时EIN组内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性与PN组比较差异无统计学意义;营养后7 d,EIN组内毒素、TNF-α、IL-1β、IL-6、IL-10及单核细胞NF-κB活性分别为(2.70±O.13)ng/L、(30.13 4±8.12)ng,L、(20.17±8.04)ng,L、(36.43±8.24)ng,L、(86.45 ±14.54)ng/L、(70.4±3.2)%,均较PN组的(3.25±0.32)ndL、(313.42±144.35)ng/L、(155.29±32.78)ng/L、(324.15±31.47)ng/L、(472.72±48.55)ng/L、(88.4±5.3)%明显下降(P<0.05或<0.01).结论 早期肠内免疫微生态营养能有效减轻内毒素血症,减低NF-κB活性及细胞因子浓度,维持促抗炎反应平衡,改善患者病情及预后.     

附睾腺癌1例

患者,53岁,1985年3月9日入院.4个月前无诱因感下腰部坠胀,随即发现右阴囊有一肿物,逐渐增大,并疼痛。呈阵发性胀瘤伴腰部酸痛、食欲下降.曾在当地医院以“附睾结核”用抗结核药物治疗无效.外科情况:右侧腹股     

大肠癌组织中C—myc基因的表达及临床意义分析

目的检测大肠癌组织中原癌基因（C—mye）的表达，探讨其在大肠癌的发生和发展中的作用。方法收集60例大肠癌组织标本，免疫组化及半定量聚合酶链反应法（RT—PCR）检测C—mye蛋白及基因表达情况。咎果60例大肠癌标本中C—mye蛋白共有38例（63．3％）阳性表达；RT—PER见C—mye基因阳性标本占91．7％（55／60），表达均随大肠癌的分化程度递减而增加（P〈0．05）。结论C—mye基因在不同分化程度的大肠癌中表达差异有统计学意义，对肿瘤的发生发展起重要作用。